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RD81  L9732  Anesthesia  don'ts/ 


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'  ANESTHESIA  DON'TS* 

By  JOSEPH  E.   LUMBARD,   M.  D. 

NEW   YORK 

ANESTHETIST  TO  THE  HARLEM,  THE  GENERAL  MEMORIAL,   THE  RED 

CROSS,  AND  THE  LYING-IN  HOSPITALS,   MEMBER  A.  M.  A., 

FELLOW  N.    Y.    ACADEMY  OF  MEDICINE. 

General. 

1.  Don't  use  ether  or  chloroform  that  is  not  trans- 
parent, colorless,  neutral  in  reaction,  or  which  leaves  a 
residue  upon  evaporation. 

2.  Don't  forget  that  the  selection  of  the  proper  anes- 
thetic is  as  important  as  its  administration.  - 

3.  Don't  forget  that  it  is  always  your  duty  to  use  the 
safest  anesthetic  at  your  command. 

4.  Don't  use  an  inhaler  which  cannot  be  sterilized. 

5.  Don't  let  convenience  preclude  safety  in  the  sel- 
ection of  chloroform  instead  of  ether,  or  ethyl  chloride 
instead  of  nitrous  oxide. 

6.  Don't  forget  that  morphine,  if  properly  used  in 
well  selected  cases,  especially  in  alcoholics  and  athletes, 
is  a  valuable  adjunct  to  a  smooth  narcosis,  but  should  be 
given  at  least  one-half  hour  before  beginning  the  anesthesia. 

7.  Don't  assume  because  your  patient  has  been  anes- 
thetized once  without  bad  results  that  you  do  not  have  to 
be  on  the  alert  in  future  administrations. 

8.  Don't  forget  that  there  may  be  danger  although  the 
patient  has  no  organic  disease. 

9.  Don't  forget  that  the  excessive  use  of  tobacco  will 
often  prevent  a  smooth  narcosis. 

10.  Don't  always  expect  a  smooth  anesthesia  with 
patients  who  are  '"bad  travelers"  on  land  or  sea. 

11.  Don't  forget  that  no  one  anesthetic  will  do  for  all 
cases  under  all  circumstances. 

12.  Don't  be  governed  by  percentages  or  the  amount 
of  anesthetic  used,  but  by  the  condition  of  the  patient. 

13.  Don't  forget  that  the  respiration  is  the  most  im- 
portant thing  to  watch,  no  matter  which  anesthetic  is 
employed. 

14.  Don't  forget  that  the  depth  of  respiration  is  the 
most  trustworthy  of  all  signs. 

15.  Don't  forget  that  the  greatest  factor  in  safety  lies 
with  the  experience  of  the  anesthetist  more  than  with  the 
anesthetic  or  inhaler  used. 

*Read  before  the  Washington  Heights  Medical  Society,  Octo- 
ber 24,  1911. 

.V?i-...  da  Umtrtnftj 


16.  Don't  forget  that  there  is  always  a  chance  for  any 
patient  to  act  badly  and  possibly  die  under  the   anesthetic. 

17.  Don't  forget  that  oxygen  added  to  ether  or  chloro- 
form will  often  make  a  narcosis  safe  that  would  not  be  so 
otherwise. 

18.  Don't  forget  that  it  is  easier  (and  much  safer)  to 
add  to  than  to  subtract  from  when  administering  anes- 
thetics. 

19.  Don't  be  afraid  to  give  anesthetics  in  chronic 
cardiac,  pulmonary,  and  renal  conditions. 

20.  Don't  forget  that  most  trouble  in  the  administra- 
tion of  all  anesthetics  comes  from  using  too  much. 

21.  Don't  forget  that  the  color  of  the  ear  is  a  very 
good  guide  for  the  beginning  of  cyanosis. 

22.  Don't  resort  to  intratracheal  or  rectal  anesthesia 
when  simpler  and  safer  methods  will  accomplish  the  same 
purpose. 

23.  Don't  expect  to  relieve  mechanical  obstruction  in 
the  respiratory  tract  by  hypodermics. 

24.  Don't  watch  the  operation,  even  if  you  can  do  so 
without  neglecting  your  patient;  it' does  not  inspire  the 
surgeon's  confidence. 

25.  Don't  attempt  to  secure  deep  anesthesia  in  empy- 
ema cases;  use  just  as  little  of  the  anesthetic  as  possible. 

26.  Don't  forget  that  surgical  shock  may  apparently 
deepen  the  anesthesia  and  cause  alarming  symptoms. 

27.  Don't  forget  that  it  is  illegal  to  have  a  nurse  ad- 
minister an  anesthetic  in  the  State  of  New  York. 

Chloroform. 

1.  Don't  let  the  surgeon  hurry  the  anesthetist,  espe- 
cially when  using  chloroform. 

2.  Don't  have  too  much  covering  on  the  mask  when 
giving  chloroform.      Always  give  the  patient  plenty  of  air. 

3.  Don't  administer  chloroform  with  the  patient  in  the 
sitting  posture. 

4.  Don't  advise  long  or  deep  inspiration  when  using 
chloroform. 

5.  Don't  forget  that  the  majority  of  deaths  under 
chloroform  have  occurred  during  the  first  period  of  its 
administration. 

6.  Don't  forget  that  while  the  toxic  effects  of  chloro- 
form often  show  themselves  very  suddenly,  they  may  be 
delayed  for  days. 

7.  Don' t  assume  because  you  have  used  chloroform 
with  good  results  in  obstetrical  cases  that  you  may  use  it 
promiscuously  in  all  other  cases.  Chloroform  is  not  free 
from  danger  in  obstetrical  cases. 


8.  Don't  use  chloroform  in  obstetrical  work  when  the 
uterine  contractions  are  feeble  and  the  fetal  heart  cannot 
be  heard. 

9.  Don't  use  chloroform  in  a  small  room  lighted  by 
gas. 

10.  Don't  lose  sight  of  the  eye  reflexes  when  giving 
chloroform. 

11.  Don't  administer  chloroform  by  a  closed  inhaler. 

12.  Don't  charge  a  patient  up  with  chloroform,  as  is 
so  often  done  with  ether. 

13.  Don't  use  chloroform  for  the  removal  of  tonsils 
and  adenoids. 

14.  Don't  forget  to  add  a  few  drops  of  ether  when 
using  chloroform. 

Ether. 

1.  Don't  forget  that  ether  is  a  stimulant, while  chloro- 
form is  a  depressant. 

2.  Don't  forget  that  ether  usually  gives  warning  of 
approaching  danger  which  chloroform  is  not  apt  to  do. 

3.  Don't  forget  that  ether  has  a  larger  latitude  for 
safety  than  chloroform;  but  do  not  abuse  it. 

4.  Don't  rely  on  this  comparative  safety  of  ether  and 
allow  its  administration  by  a  novice  unless  absolutely  neces- 
sary. 

5.  Don't  forget,  generally  speaking,  that  ether  is  much 
safer  than  chloroform  and  certainly  should  have  first 
choice,  other  things  being  equal. 

Nitrous  Oxide. 

1.  Don't  be  alarmed  at  slight  cyanosis  when  using 
nitrous  oxide. 

2.  Don't  forget  that  jactitation,  when  using  nitrous 
oxide,  calls  for  more  oxygen. 

3.  Don't  forget  that  nitrous  oxide  can  be  given  safely 
at  any  age. 

4  Don't  forget  that  nitrous  oxide  and  oxygen  is  the 
safest  anesthetic  known,  but  is  not  always  satisfactory  to 
the  surgeon. 

5.  Don't  fail  to  have  a  witness  when  inducing  anes- 
thesia, especially  when  using  gas.  Many  law-suits  have 
resulted  because  this  precaution  was  not  taken. 

6.  Don't  forget  to  empty  the  bladder  before  giving  gas 
to  children,  as  they  often  urinate  while  under  its  influence. 

7.  Don't  forget  that  nitrous  oxide  is  the  safest  anes- 
thetic for  short  operations  and  examinations. 

8.  Don't  expect  a  good  anesthesia  when  using  nitrous 
oxide  on  alcoholics. 


Relation  to  Patient. 

1.  Don't  starve  or  purge  a  weak*  patient  too  much 
prior  to  anesthesia. 

2.  Don't  forget  to  secure  the  patient's  confidence 
before  commencing  the  administration  of  the  anesthetic 
and  begin  very  slowly  and  quietly.  Allow  neither  talking 
nor  noise  in  the  room.  You  will  thus  contribute  to  a 
smooth  narcosis. 

3.  Don't  forget  to  ask  the  patient  if  he  is  accustomed 
to  sleep  with  his  head  high  or  low  and  govern  yourself 
accordingly  when  administering  the  anesthetic. 

4.  Don't  forget  that  the  nose,  mouth,  stomach,  bowels 
and  bladder  should  be  empty  before  beginning  anesthesia. 

5.  Don't  forget  to  have  teeth,  nose  and  buccal  cavity 
clean  before  giving  the  anesthetic. 

6.  Don't  forget  to  keep  the  patient  warm  at  all  times. 

7.  Don't  forget  to  wash  out  the  stomach  when  it  is 
full.  The  anesthetic  will  act  more  quickly  and  more 
safely. 

8.  Don't  forget  that  the  change  of  posture  may  add 
greatly  to  the  patient's  comfort  and  safety. 

9.  Don't  forget  to  give  a  drug  friend  his  usual  dose 
before  anesthetization. 

10.  Don't  worry  about  the  pulse  if  the  respiration  and 
the  color  of  the  face  are  satisfactory. 

11.  Don't  be  alarmed  when  the  pulse  is  a  little  weak 
or  rapid.      Look  for  the  cause  and  remedy  it. 

12.  Don't  go  over  the  safety  line  in  trying  to  relax  the 
.abdominal  muscles  in  acute  conditions. 

13.  Don't  forget  to  withdraw  the  anesthetic  immedi- 
ately when  you  have  a  widely  dilated  pupil,  fixed  eyeball 
and  eyelids  partly  open.  This  means  that  too  much  has 
been  given. 

14.  Don't  forget  that  a  dilated  pupil  with  a  moving 
eyeball  means  that  not  enough  has  been  given. 

15.  Don't  forget  to  drain  the  mucus  from  the  mouth 
by  means  of  a  gauze  wick  or  suction  apparatus. 

16.  Don't  deceive  children  about  to  be  anesthetized. 
Don't  forget,  first,  last,  and  all  the  time,  to  keep  your  whole 

attention  fixed  on  the  administration  of  the  anesthetic. 
Graham  Court,  1925  Seventh  Avenue. 

Copyright,  William  Wood  A  Company. 


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